Brinzolamide/timolol provides greater morning IOP reduction and lower eye irritation than dorzolamide/timololBrinzolamide and Timolol Show Better Morning Pressure Reduction for Glaucoma

PurposeThis systematic review and meta-analysis aims to compare BT and DT in terms of intraocular pressure (IOP) reduction, safety, and patient preferences.MethodsFollowing PRISMA and Cochrane guidelines, we searched PubMed, Scopus, Web of Science, CENTRAL, and Embase up to December 30, 2024. Twelve studies (11 randomized controlled trials [RCTs]) involving 1,885 patients were included. Primary outcomes were IOP reduction and adverse events. Statistical analyses were performed using Review Manager 5.4.1, with mean differences (MD) and risk ratios (RR) calculated for continuous and binary outcomes.ResultsBT demonstrated a statistically greater reduction in the morning IOP compared to DT at 12 weeks or more (BT: MD = 0.56 mmHg,  < 0.001; BTFC subgroup: MD = 0.66,  < 0.001), with consistent benefits observed at 8 and 4 weeks. No significant difference was observed in the evening IOP reduction. BT combination was associated with a 49% lower risk of eye irritation (RR = 0.51,  < 0.001) but a threefold higher risk of blurred vision (RR = 3.14,  < 0.001). Patient preference studies favored brinzolamide/timolol fixed combination (BTFC) due to reduced ocular discomfort.ConclusionBT showed a statistically greater reduction in morning IOP than DT; however, the absolute difference was modest, and its clinical relevance is uncertain. BT was associated with less ocular irritation but higher blurred vision risk. High heterogeneity for evening IOP and overall adverse events limits interpretation. Considering these findings, the choice of treatment usually depends on the patient's tolerance to higher initial ocular irritation in DT or blurring of vision in BT. Longer-term trials with 24-h IOP and preference are needed to assess these outcomes meaningfully.